"MINE"(Amelia's bagel) near Grandma's legs in her stylish surgical stockings.
















Natalie watches Andy enjoying his snack.
















Holly & Amelia -- I think we're about done here. Find out more about McWane Science Center here: http://www.mcwane.org/

Shogun in Birmingham

Here we are ordering a delicious Japanese dinner at Shogun with Larry's family & Holly & Michael . . .
















Patient little & big people.
















Lisa & Andy "kampai!" their drinks.

Holly & Michael are intrigued by our performing chef -- but they don't do this in Japan . . .

















Natalie will try anything!















Onion volcano!

In Birmingham

Just one of the delicious meals Holly & Michael served us . . .

Holly & Michael's cats: Gus




















Octavia (Tavie) . . .
















and of course, Baby

Vulcan statue peeking over the trees on Southside Birmingham.















Near UAB . . .

Outside of the "new" Fish Market near UAB in Birmingham.

This waiter apologized for walking in front of my camera (how Japanese of him!), but I told him he added more to my pic!















More of the interior of the new location. I loved that they moved into this great old warehouse -- not too far from where they've always been!

I see a Japanese flag above the bar.















I love the space & decor in the "new" Fish Market!
















Ken & Carol

Sue & Bill















Stan & Ken















Margie & Sue -- I loved my meal, but you can see by my face that I was in pain . . .

Margie's Total Knee Replacement Story

After years of adapting to worsening knee pain (apparently an epidemic of our baby-boom generation!), I was seen by a visiting orthopedic surgeon February 2007, and was surprised by his diagnosis. X-rays revealed that TKR (total knee replacement) was my ONLY option due to degenerative osteoarthritis in both knees. I was given cortisone cocktail injections in both knees (VERY painful) and told I would be put on a list to receive injections every 3 months, each time when the orthopod returned to Iwakuni. In a day or two, almost all pain had subsided and I felt better than I had in years!

In May, when the visiting orthopod returned and I got my second set of injections, I found out that I could only get 3 injections total – ever! – then I would either return to living with the pain or choose to have the surgery. I got busy considering my options. I was advised that military hospitals, because we’re civilians, would likely not be able to work me in, and of course ours on base is just a clinic. The closest military hospital is in Yokosuka, near Tokyo. I then researched and considered Bumrungrad Hospital in Bangkok, one of the finest hospitals in the world, which was highly recommended. Or I could be referred off-base (probably Hiroshima) for surgery, so I checked with our friend, Hiroshi-san for his orthopedist who was also highly respected. My fourth option was was to return to the US for surgery.

One night, I asked our neighbor, who was a flight surgeon on base, what he would recommend for his mother. Without hesitation, he said there were many excellent places to have TKR, but I should stay at least two months after surgery before returning to Iwakuni, because of our clinic’s limited facilities. I would be in trouble if any complications were to develop. This turned out to be the best advice I received! Staying somewhere away from home for 2 months after surgery could be a lonely and expensive experience, and traveling by train within Japan would be tiring and difficult with a recovering knee. This information greatly limited my choices. It made more sense to return to the US since we go during the summer anyway. And Birmingham seemed to be my best option. I could stay with Holly and many friends there to help keep me company during recovery. When you get to the bottom of the page, click "Older Posts" (underlined below right) to see more of this story - photos too!

Above is what a "normal" knee joint should look like. Below is my pre-surgery X-ray. As you can see there is basically no cartilage left in either knee & lots of damage from arthritis. This is bone crunching against bone . . . which explains the constant pain & knees "locking up" on me.

When I found Dr Bramlett and AL Sports Medicine Clinic in my internet research http://www.osmcoa.com/bmis.html, I knew I had found the right fit for me. My decision was based on his minimally-invasive TKR replacement technique (MIS). Of course, total knee replacement IS extremely invasive (basically, your leg is cut off, repaired, joints replaced, and reattached by a team of surgical carpenters!), but MIS technique uses a smaller incision and does not cut the muscles and tendons. This shortens the time required in surgery from several hours to less than an hour, which equates to less stress on the body and less blood loss. His procedure does not require a tourniquet, nor did I require a blood transfusion. All of this was very appealing to me and I emailed and received prompt answers to all my questions from his helpful staff. Holly and Michael (God Bless ‘Em!) were more than willing to let me recuperate for two months at their home. I scheduled surgery for July 25, which would allow us to vacation with children and grandchildren and Stan could stay to help me for the first two weeks before he had to return for the start of school. Although I consider myself relatively physically active for my age and limitations, I began to follow Dr Bramlett’s schedule of pre-habilitation and added his isometric exercises to my regular routine. Bicycle riding was also required, but this was already something I did daily for transportation.

In mid-June, off we went to the US. (Check out pictures elsewhere to see all our beautiful children and grandchildren and the fun stuff we did all summer.)

To continue, click "Older Posts" below right . . .

Finally, after weeks of research, planning, pre-habilitation (exercising in advance to strengthen muscles around the knees), and vacation with family & friends, July 25 arrived. And of course, Pastor John Mount from our home church, Aldersgate United Methodist in Birmingham was there when Holly, Stan and I checked in at Brookwood MC. http://www.bwmc.com/CWSContent/brookwood-medical/default.aspx As I walked back to my pre-op room it was a weird feeling to know that this was the last time I would walk with my old right knee, and I knew I would feel worse before I felt better. But I was excited about being better!

The pre-op room was actually more like a very large ward, with curtains around each bed for privacy. On this day, a new style patient surgical gown was being tried for the first time. It inflated with warm air to keep the patient warm and it was puffy and purple. A heated suit really didn’t appeal to me in late July, but I turned it on it to “cool.” I soon began to blow up like the little girl who turned into a blueberry in the Willie Wonka movie, and we all had a good laugh. An IV was started with fluids, which made me feel better, because I was dehydrated from not being able to drink water before I went to bed or after I got up that morning. Holly and Stan stayed with me until it was time to go back for surgery. A nurse wrote “Yes” on my knee to be sure they operated on the correct one. Click "Older Posts" below right to continue . . .

An anesthesiologist came in to assure me I would not be aware of anything during surgery. I told him I didn’t even want to see the operating room! He said I would soon get something in my IV to help me relax. Dr Bramlett came in between patients to say “hi” and said it wouldn’t be long now. I don’t really remember much else after that. Holly said I did ask someone to try to make me taller while they were working on my leg, but I don’t remember saying this . . .

I woke up and was told it was all over, but I couldn’t believe it since it felt like only a few minutes had elapsed. (Actually, it was less than an hour!) I remember my right leg feeling cold, but no pain. Soon after being moved to my room, I was given morphine and I became extremely nauseated. The nurse said I was also sick right after surgery (thankfully, I don’t remember), so no more morphine for me. My doctor did not use the patient-controlled pain pump, but the nurses were wonderful about keeping me comfortable and no one ever said, “it’s not time yet.” At first, I really couldn’t tell cold from pain, but I soon realized that when I felt that deep, bone cold feeling, pain soon followed.

Stan or Holly stayed overnight with me while I was in the hospital. In my research, everything I read said it was best to have a family member around at night and I REALLY appreciated my family doing this for me.

There was a cooler on the floor with ice that constantly pumped cold air around my whole right leg. I’m assuming this was to keep down swelling and bruising. Of course, once my leg was un-bandaged, I could see that it was indeed swollen and completely purple. Click "Older Posts" below right to continue . . .

The second day a PT got me up on a walker. It was very scary, and I couldn’t imagine how I would ever be able to walk again. I kept thinking my knee would surely pop open if I put my weight on it! My right leg was bandaged from the top of my thigh all the way to my ankle, so I guess it would have been impossible, but I was wary, just the same, and terrified of falling! Each day I was in the hospital, PT came in twice a day to watch me walk me down the hall on a walker. I didn’t make much progress at first, but gradually I became a little stronger. Although I hadn’t lost enough blood to require a transfusion, I was very, very weak, which surprised me. After walking just a few yards down the hallway, I would come back and collapse in bed, exhausted. I couldn’t imagine that I would ever feel like myself again! On the second day (I think) my IV was removed as well as my drain because I was scheduled to leave on day 3. The next morning I learned how to go up and down stairs, since I would be going home to Holly’s and the bedrooms are upstairs in her house. I really felt worse on day 3, however, and did not feel that I was ready to leave, so I opted to stay one more day. You may have to insist, but it's never good to go home too early!

All the hospital staff who came into my room were professional and kind and it was a better experience that I had anticipated. You hear so many scary things these days about hospitals and I’ve not been hospitalized very many times in my lifetime.

On Day 4, I was feeling much better and ready to go home. I remember being wheeled out and trying to figure out how to get my stiff right leg into the passenger side of our small rental car. Wow – wish Stan had rented something larger! The ride home felt very rough and I was glad to climb into bed when we arrived at Holly's.

WARNING -- GROSS PICTURE BELOW!

My right knee has a Frankenstein-quality to it. Stan thinks I may have won the family record for total number of stitches, if staples count . . . of course there's a bunch of actual stitches inside.














Click "Older Posts" below to continue with this story . . .

The first week or so after surgery was somewhat of a blur – probably partly because of the wonderful pain meds, and partly because I was so weak. I don’t like feeling helpless, but I really was, and this was a terrible condition for me. In order to make life a little easier, we bought a potty chair for next to my bed, a walker, a shower chair, and a bathtub grab bar that attached to the edge of the tub. Also, Holly’s super neighbors (several of whom also brought dinner!) loaned me suction safety handles that you could attach anywhere and they were wonderful to grab for security and help me get in and out of the tub for my showers. Just getting showered was an ordeal and I would have to rest in bed afterward to get the energy to dress and put on my surgical stockings, so I could go downstairs. Sleeping on my back quickly became very tiresome, but turning over was not possible for a while. Mostly I slept, ate and continued my isometric exercises as much as I could tolerate. I watched a lot of TV while I was downstairs during the day and fell in love with TiVo! My bedroom at Holly's had everything within reach -- my walker, potty chair, meds, wound care items, books. Holly even brightened it up with some cheerful flowers. Yes, I slept a lot, but I'm still stifling a yawn.

















Here you can see my baggie of lotion, powder & deodorant, and my hairdryer, makeup, purse & cane, and a pillow on which to prop up my leg. I quickly learned to keep everything within reach!















Click "Older Posts" below right to continue . . .

August 5 (10 days post-op) I went to church that morning on my walker and everyone seemed surprised to see me. That evening, we had an outdoor ice cream social with the choir providing entertainment, and I didn’t want to miss that, either! I still could not bend or straighten my knee very well and remember feeling uneasy if anyone got too close.



















That's Holly in the white shorts.















Beverly, Sue & me - enjoying our cooling fans & ice cream. It felt good to take my surgical stockings off! Notice they're hanging on my inverted walker, which was being used as a footrest.















Turner & Clay -- Sue's precious grandsons -- helped me to my car & boy! have they grown this past year!














Click "Older Posts" below to continue . . .

Aug 6 – (12 days post-op) was my first post-op checkup.





























I came in on my walker, and Dr Bramlett said, “You don’t need that! Get up and walk!” So I did and I never used the walker again. Just my cane for a short while, which never failed to remind me of Igor in Young Frankenstein – “walk this way” . . . Also, it was a nice prop. It’s amazing how much nicer strangers are when they think you’re handicapped . . . However, no matter how many handicapped parking spaces there are in Alabama, we rarely ever found one available!



















What a difference in these "After" X-rays! I'm so bionic with my Stryker gender-specific knee! How cool am I?http://www.aboutstryker.com/knee/treatment/triathlon.php
The surgery was computer-assisted, so my leg is sooo much straighter that initially, I felt like I was walking on the outside edge of my right foot. Even the inside of my kneecap was "cleaned out" and replaced with a new, smooth part.














Side view . . .














Click "Older Posts" below right to continue . . .

Although I was more concerned about bending my knee, Dr Bramlett was more concerned about straightening (he's also a perfectionist), which he said would lead to bending. Staples were removed (not as bad as I anticipated!) and steri-strips used to hold the wound together.
































To continue with this story, click "Older Posts" below right . . .

Weekend of Aug 11th and 12th – Larry and family came down to visit and we spent Saturday afternoon at the McWane Museum downtown. (pictures elsewhere) I walked a lot and rested a lot, but had a wonderful time with Andy, Amelia and Natalie. On Sunday morning, Sherri and David drove over from Atlanta and went to church with all of us and afterward we visited for a while at Hollly’s. Then Larry’s family left and Sherri and David left to drive Stan back that afternoon to spend a few days with Sherri before flying back to Japan. He was a wonderful help, but I know Stan was ready to leave and get some rest after waiting on me hand and foot! I was not a very good or patient patient . . .

Aug 15, Stan left Atlanta for Japan. I’m so thankful that I decided to stay longer. There is no way I had the energy to make that long arduous trip when he did. Of course, Holly and Michael were wonderful (I joked that it took a staff to take care of me!) preparing and serving a delicious & healthy dinner each night. I couldn’t have had better or kinder help, and I could not be more grateful! Click "Older Posts" below right to continue . . .

On the stationary bike, although Tavie enjoyed it much more than I did!

Aug 16 was my 3-week post-op checkup and Dr Bramlett was very pleased with my progress. My flexion was 90 degrees, aiming for 110. I told Dr Bramlett that I’m very impatient and wanted to make faster progress, so he sent me downstairs to start physical therapy in his rehab, a large, beautiful room in the lower level of the clinic with every kind of modern equipment. I told my therapist that I wanted to come every day since I would only be in the US until the end of September, and I had to be able to ride my bicycle by the time I returned to Japan. So began a grueling, but productive schedule. I had one week off when I was “forced” to accompany Holly and Michael to Gulf Shores for a week (8/23-30), but otherwise I was working hard. Even in GS, I was in the pool a couple of hours each day working out. I only made it to Lakeshore a couple of times during my recovery, but with PT every day, I was really too tired to also do the water aerobics class. I did manage to have a delicious lunch and nice visit with Irene one day. I was walking, but rather stiff-legged, so I had to constantly remind myself to bend my right knee. I was surprised that my knee “forgot” how to bend . . .

I'm healing nicely, but still wearing the surgical stockings. That was a long, hot 4 weeks!

The following weekend, the Crowls were in Birmingham for Heather’s 20th HS reunion, and Sue and I babysat for Kelly and Cody. (see pics elsewhere) What fun! Of course, there was no way I could have done it alone, but as always, Sue was eager to help! On Sunday, they all came to church so everyone could see those beautiful children. Then they continued on to Nashville to visit with Larry and family. Keep going to continue this story - click "older posts" below right.

A few days later, I decided I should probably have someone check the small breast lump that I had been feeling for a couple of months, so I went to Holly’s doctor, who referred me to a surgeon. He did an ultrasound and said we could watch it for a while or go ahead and perform a biopsy. I opted for the proactive approach and scheduled a surgical biopsy two weeks before I was due to return to Japan. I began to feel somewhat like my 60-year Warranty had expired . . .

Sept 6 was my 6-week post-op checkup and I was released by Dr Bramlett, although I continued PT until time to leave for Japan. I was completely off the cane by now and walking quite well on my own. I still tired easily, but I felt stronger and more energetic every day. At this point, I still could not imagine doing this again next year for my left knee. Maybe in a couple of years? All I could think about was what I would do if I had breast cancer . . . how would I proceed? And when would I get to return to Japan?

So, Friday Sept 7th I returned to Brookwood and it felt like "deja vu all over again" - returning to pre-admit and pre-op. Dr Shumate decided to go ahead and remove the entire lump since it was small, and I totally agreed. Fortunately, the lump was small and right under the skin, so I didn’t have any discomfort after surgery and a very small incision. After a few nerve-wracking days, on 9/12, I received THE call that it was benign – Thank you, thank you, thank you God! PLEASE CLICK ON "OLDER POST" BELOW TO CONTINUE WITH MY TKR STORY . . .

Meanwhile, I continued my PT until time to leave Birmingham for Atlanta on 9/21. My physical therapist was pleased that my right knee had reached 107 degrees of flexion by my last day of PT. Holly drove me to Atlanta and we had a great weekend together before she left to return to Birmingham. (see pictures elsewhere.) Then Sherri, David and I had several more fun days touring and eating our way through Atlanta before I returned to Japan on 9/27.

Sure enough, the long trip was more exhausting than usual, and although I tried to get up and walk around every couple of hours and had wheelchairs push me at the airports, my knee was stiff and painful when I arrived home – worse than it had felt in weeks! I was SO scared that I had done some damage or suffered a setback, but after a few days of rest and gentle stretching, it slowly got better. The first couple of weeks back in Japan were difficult and I felt rather trapped at home. Of course I could drive if I wanted to, but I was determined to get back on my bicycle and regain my confidence! PLEASE CLICK "Older Post" BELOW TO CONTINUE THIS STORY . . .

Now, at 3 months post-op, I’m thinking about doing it all over again next summer with my left knee. Not having constant pain in my right knee is glorious and I dream of being able to stand and walk totally pain-free! Although it was scary at first, and I can’t yet navigate my 2-wheeler, I’m riding my 3-wheeler and getting everywhere I want to go. It's perfect therapy for me, and I’m back in the pool 4-5 days a week - I believe that physical therapy NEVER ENDS! and my confidence level is increasing every day.

So, that’s it. It’s a long story (sorry!), but you know me – details, details, details and I hope you take away something from this. Before I had surgery, I did a LOT of research, and could find no narrative of anyone who had a TKR experience, so I wanted to share mine. I have absolutely NO regrets, although it was very rough for a while, and (yet another!) lesson in patience for me. I totally recommend NOT waiting for TKR when arthritis pain interferes with your lifestyle. I’m just not ready to sit down and miss out on life yet – I have too much left to enjoy! Thanks to all of you who took care of me, sent cards, called, prayed, and thought of me during my surgery and recovery. ~ Margie Stevens